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2. Name of Business:*
3. Name of Business Owner:*
4. Business Email Address:*
6. Business Address:*
7. Zip Code:*
8. Business Phone:*
10. Is your Mailing Address different from your Business Address?*

    1. Yes
    2. No
12. Mailing Address:*
13. Mailing Zip Code*
14. Cross Streets:*
    Please enter in cross streets between business address.
16. Description of Proposed Home Business and Type of Activities:*
18. Sales and/or Services Conducted:*

    (check all that apply)

    1. On the Premises

    1. Away from Business
19. Hours of Operation:*
20. Days of Operation:*
22. Average number of customers coming to the home for business purposes:

    For example: appointments, picking up, training, consultations, etc.

23. Per Day:*
24. Per Week:*
26. Is the business a Cottage Foods Operation?*

    1. Yes
    2. No

    A Cottage Food Operation is an enterprise at a private home where low risk foods products are prepared or packaged for sale to consumers. If yes, contact planning division at 209-577-5267.
28. Acknowledgement*

    1. By checking this box, I agree to the below terms.

    I declare under penalty of perjury that I have read and hereby agree to abide by all the rules and limitations for operating a Home Business in the City of Modesto.

30. Note: If we receive a complaint about the operation of the business, it is our duty to investigate so that we can verify the facts and help to make corrections or adjustments so that the problems can be solved. Our desire is to help both the complainant and the licensee. If you have any questions, please call the Planning division at 209-577-5267. Mail the top two copies to the City of Modesto, P.O. Box 3442, Modesto, CA, 95353.

32. Business Owner Name:*
33. Business Home Address:*
35. Digital Signature*
    Provide your digital signature in order to indicate your agreement with the terms of this application. Your digital signature must be between two forward-slash (/) symbol. An example of a valid digital signature is /John Doe/.
36. Link for Home Business Municipal Code Reference
    10-3.207 Home Business Municipal Code
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field